"Addiction" is ambiguous and a term almost better not used. "Addiction" may constitute chemical dependency but can also be largely a set of habits. A set of habits and lifestyle are pretty much the same thing.

Masking reality is not a good way to work within it nor modify it.

Nobody has yet been on these drugs for an entire lifetime - which is what is being advocated in this thread.

But no one has proposed mechanisms for GLP1 peptides.

Meanwhile, we know obesity is one of the largest long term risks to health in existence, and one of the most prevalent.

I'm worried about long term malnutrition leading to significant loss of muscle mass, osteoporosis, and other deficiencies that eventually lead to infirmity and brings forward the immobility death spiral much earlier in late age through weak muscles and bones. Most of the long term studies on GLP-1 agonists that I've reviewed have been on diabetic patients who already had to carefully control their diets and we still don't know what decades of poor diet on Ozempic will do.

For very obese people the tradeoff is still pretty damn good though.

It's not great.

The good news is it's quite commonly reported (and I can add my anecdotal experience to the chorus) that I don't crave the food that's worst for me in any real quantity anymore. Even if I'm busy and need to scroll through uber eats, I'm not using it as an excuse to get a delicious but large, fried, high in carbs, high in fat meal. It's way easier for me to say "yeah that tastes good, but I'll grab the grilled chicken wrap and brown rice."

I'm not sure on what causes this - we have some preliminary studies around GLP1 peptides, dopamine, addiction, etc., so it might be something there. But the sheer number of people you hear talking about it makes me believe we'll have some studies that do look into it in the future. It might not happen to everyone, and some people might still just choose to eat poorly even if it does, but in both situations people's longterm health depends on them listening to advice on how to eat better and exercise, and I think most people would rather be average weight and metabolically unhealthy than obese and metabolically unhealthy.

To use an analogy amphetamines have a honeymoon period, and it feels like a lot of people on these weight loss drugs haven’t been on them long enough to get past the honeymoon period and see what the effects are after 10, 20, etc years

I don't think anyone who is both informed and sane would suggest that it is impossible that there are negative long term impacts from taking the medication. Just that we have no current indication of them, and that being afraid about a "what if" without any concrete concerns when the alternative is the "continue being in one of the riskiest states possible for human health" is silly.

We do in fact know a lot about how these drugs affect people by now, and as you point out, we have well over a decade of data on them.

I knew about it from prior research, but my doctor made sure to mention it to me as well. He's also monitoring the speed of my weight loss to determine if I should go on ursodiol to prevent gallstones - another potential side effect of rapid weight loss.

But the same could happen on any sort of caloric deficit. The GLP1 drug isn't causing you to lose muscle through some reaction occurring inside your body - it's your body just doing what it does in a calorie deficit when you aren't overindexing on protein and working out.

The pill alone isn’t magic. It just makes it possible to do the right things for people who found it impossible to do before.

Tirzepatide also has significantly fewer GI issues.

Muscle mass loss happens in any sort of weight loss where you don't eat enough protein and get enough exercise. There's no current evidence that when you control for calorie deficit, diet macros, level of exercise, bmr, etc., that people lose more muscle mass on GLP1 agonists to my knowledge.

Tirzepatide is being investigated as a therapy for IBS. Within two weeks of being on the drug I was able to start living a life not scheduled around being near a restroom. This was suggested as a potential side effect by my doctor before taking it for weight loss, due to the GIP component in the drug which slows down your digestive track.

It could be I’m eating less. However I have went on crash diets before with absolutely no change to my constant lifetime GI issues, and have eaten extremely clean the past half decade due to a partner who cooks amazing healthy meals that would exceed most definitions of the term.

I’ve long since reached my goal weight and target body composition- but I plan on sticking to a low dose of Tirzepatide for the rest of my life since it gave me my life back. No more popping Imodium every few hours on vacation while simultaneously fasting. Just a normal life these days. I can enjoy a breakfast if I feel like it without it ruining the rest of my morning. Heck, I can even eat shitty greasy food at the state fair with only mild discomfort most folks would have from such poor choices.

Every study (still limited in number) I’ve read more or less refutes all the social media hysteria. There is a whole lot of smoke but no fires yet to be seen. They may still be coming.

The things that are not wholesale misinformation seem to be the requirement to cease use many weeks before going into surgery, potentially needing to be on it for your whole life, and the side effect it currently has on your finances. Nothing else seems to hold up under scientific scrutiny yet.

Perhaps I will regret this decision in 20 years, but I’m willing to take that risk to have some of the best quality of life years I’ve had yet.

Cessation tools are not negative. Yes, root causes of abuse should be addressed, but aids are aids.

    Crutch (n)
    a : a support typically fitting under the armpit for use by the disabled in walking
    b : a source or means of support or assistance that is relied on heavily or excessively

It might be more good faith to just pick language that is more clear. The alternative feels a lot like pretending to be one thing while trying to make people think something else - it rings just like a bad faith "Im just asking questions"

That _OR_ is doing a lot of work. I believe that 'or' makes the word not objectively pejorative. Context is important. A no-true-scotsman insinuation, or an insinuation that the crutch will never be removed does lack empathy and would seem pejorative to me.

Though, an empathetic concern that the crutch will never be removed - is not necessarily pejorative IMO. Either way, the crutch is a tool to "healing." Context matters.

Thus, calling GLP-1 meds a “crutch” implies that they are unnecessary, and that the patient should be able to do it without medication, which then creates guilt and shame where there shouldn’t be any.

It is so profoundly disingenuous to pretend not to know what the word "crutch" means or what connotations it has in this context. Like, come on.

But you are making a HUGE leap here in assuming that GLP1 agonists "simply are negative". You have not remotely supported this logical leap. All studies in fact have shown that GLP1 agonists are significantly positive: That they improve health, reduce obesity, reduce all-cause mortality, etc. You are denying observed reality across a large number of double blinded, objective clinical trials.

Here I am looking from western Europe at 100% self-inflicted US obesity epidemics and shaking my head in disbelief, what kind of garbage and in what massive quantities you guys consume daily. Even otherwise smart folks have a brutal mental blind spot with food. Where I live (western Switzerland bordering with France), there is almost 0 obesity at all, people have quality food (ingredients, taste, often self-preparation) as one of cornerstones of society. People love doing sports. And it shows. Kids don't eat garbage because parents don't give them garbage, because parents don't eat and overeat on garbage.

Sure, you can just literally throw money at the problem that is too scary for you to tackle it headfirst, or you can have a wake up call and make your life significantly better from now on and live longer. All is connected - it leads to higher confidence, happier healthier life. The key is to walk the hard path - overcome such a challenge will redefine who you are for the better. Taking pills every day because you can't avoid eating a cookie under stress won't, in contrary.

Yet all I see is people rushing to more drugs without even thinking, taking the 'easy' way out, just continuing with not being in control of their own lives and themselves. Is it improvement to their current helpless situation? It certainly seems so unless long term tests will say otherwise. Is this the right or optimal way to do it? Absolutely not, and that's all.

Eating right, lifting, trying to be active… all of that on top of the nausea created by the medication itself.

Obesity is such a massive epidemic, and shaming people into feeling bad about it has clearly not worked. And that’s before you consider the genetic factors, environmental factors, food deserts, and the other dozen reasons it’s so hard to stay fit for some people.

I am genetically gifted in some ways; an athlete’s metabolism was not one of them. I can be extremely disciplined, but the constant vigilance creates this “food noise” in your head that’s hard to explain, but extremely stressful, and causes you to constantly be seeking the next meal.

It used to be that every single food I put in my mouth tasted amazing (within reason). Apparently this is not true for everyone, and they have a greater and sharper distinction between “foods that are amazing” and “foods that are just fine”. That distinction exists for me now, and never really did before this medication.

There are so many ways it has helped me. My blood labs are perfect, and my liver was definitely not perfect before. My A1C was just on the cusp of prediabetic, at 5.7%. My triglycerides, ALT, AST… all were wayyyyy higher than they should have been.

A1C at last test a few months ago was 5.0%, and all the other numbers are well within low-mid range of where they should be.

Anyone that looks at someone using GLP-1 medications and thinks they’re “cheating” is a child. You still have to put in the work; you still have to eat right and work out and lift. It just makes it actually possible to do that for the first time in many people’s lives. I don’t know if you’ve ever put on a realistic “fat suit,” but trust me when I say that everything is harder when you’re heavier. A walk around the block is an insane workout if you are 450lbs and haven’t walked in years. It’s not where you should end, but it is a start, and if there is a medication that helps someone start… everyone else can fuck right off. You will never find me shaming someone else or judging them for getting healthy, which is the actual point more than just losing weight.

There is one way to get off the medication in the future (or get on the lowest dose, etc): build significant muscle mass. That’s why it’s so important to lift.

One common argument I’ve heard against GLP-1 meds is the idea that you’ll have to be on the meds forever. And for some people, maybe even most, that may be true. We don’t know yet.

But you know what’s worse than being on a GLP-1 med forever? Being obese forever. We know precisely just how that kills so many of us.

But you’re right, we should just go back to the way it was. That seemed to work just fine. :/

At some point, we may find that these drugs cause long-term health problems of their own, too.

There is no guarantee that I’ll have to be on it for the rest of my life. But also, I was not “addicted” to food.

I spent 18 months changing my lifestyle, nutrition, and exercise habits, and I lost zero weight. I gained health (hikes were no longer a problem, I was fully capable of working out after enough time doing it, etc.), but no weight loss.

Yes, I tracked. Yes, I ate below my expenditure. My body holds onto weight.

So yeah, I agree with more help for people with addictions, period. I do not see how it is a “replacement” for a medication that is clearly helping people.

A lack of therapy was not my problem.

> So many people regain all the weight they lost after stopping these drugs, so it doesn't make meaningful progress and just covers the problem.

And so many people don’t.

Also, we’re learning. Quit cold turkey and yeah, you’ll gain. Taper, and you likely won’t: https://www.pharmacist.com/Pharmacy-News/coming-off-glp-1s-s...

> At some point, we may find that these drugs cause long-term health problems of their own, too.

Or we may not; these drugs have been around since 2005. They’re not new, despite most people having just heard of them now.

But we know for a fact that obesity kills.

Again: your contention is that instead of using this medication that helped me get healthier over the last 7 months and will help me get healthier yet over the next 7-8, you would have preferred that I “accept” that I have a problem imbued with negative morals (“addiction”) and try my hardest to break it. The thing is, I had already done that for the entirety of my life, remained obese, and would have died of it eventually.

Can I be disciplined? Absolutely. I even lost 55 lbs doing keto for 10 months. I ran a startup, and successfully sold it.

Discipline wasn’t my issue.

I’m not suggesting you should use a GLP-1 med. I’m suggesting you shouldn’t be the arbiter of whether it is helpful or not; it’s effects should be.

The majority of people who are accessing this drug have endocrine systems that work just fine, but problems with controlling themselves around food. Our societal-level response is to treat it with a drug rather than helping people who really do have significant willpower problems overcoming their lack of discipline. There are hugely beneficial approaches that rely on CBT, for example, but are relatively controversial because of "weightism" concerns.

Citation needed. This is the main assumption you are making that I, and others, vehemently disagree with.

The implication is that this is the first time people have suddenly decided they don’t like being obese. That’s absurd. The people on these medications have tried everything. Talk to literally any obesity doctor and ask them about their patients.

This assumption is the problem. Nothing about the meds is easy. It just makes it possible for people to change when they couldn’t before.

I don’t know why people feel a need to argue against that.

> Our societal-level response is to treat it with a drug rather than helping people who really do have significant willpower problems overcoming their lack of discipline. There are hugely beneficial approaches that rely on CBT, for example, but are relatively controversial because of "weightism" concerns.

Sure, and I don’t disagree. And I’m all for people doing that too. If it works, great!

On average, it doesn’t, for the vast majority of people, though it does work for some, and that’s great. I agree it’s a preferable approach. But if it worked for most people, it would have worked.

But if it doesn’t work? Previously, people just accepted that they were going to be obese and miserable, and that it was their fault, which led to depression, etc., further making it “impossible” to ever fix.

So if there is a medication that helps people change their lifestyle to get healthy, and also appears to be extremely effective, and has a good safety profile… that’s bad?

Citation needed on this one. Almost all the obese people I know have never seen a specialist doctor about it, so I assume your anecdata have selection bias. The people who see obesity doctors are the ones who have tried everything. Not the average obese person.

I don't personally mind if you or anyone who really needs it and gets prescribed the thing by a specialist takes Ozempic. I don't think any drug use, be it Ozempic, abortion pills, or estrogen, should be stigmatized for the individuals taking it. I do think it's a sign of a societal ill that a large majority of the people taking Ozempic are not in that situation.

You sure? Nearly every single one I know has seen their primary about it every time they go in and if the primary referred them to a specialist they went.

What they don’t do, though, is talk about it.

Have you asked them?

> I don't personally mind if you or anyone who really needs it and gets prescribed the thing by a specialist takes Ozempic. I don't think any drug use, be it Ozempic, abortion pills, or estrogen, should be stigmatized for the individuals taking it.

Great, agreed.

> I do think it's a sign of a societal ill that a large majority of the people taking Ozempic are not in that situation.

I don’t think it’s true that “a large majority” of the people taking it are just handed the pills for fun, to lose a few pounds. Your assumption about to whom they are prescribed is my whole issue, as it assumes they don’t need it to lose weight and can “just eat right and work out,” and that is not true.

People who are obese don’t like being obese. They aren’t that way because they don’t care. They aren’t that way because they are lazy. (On average)

No, Wegovy and Zepbound are not diabetes drugs. They are weight loss drugs.

> ... but problems with controlling themselves around food.

Problems that Wegovy and Zepbound solve for most people taking them, when no other solution worked for those people.

> There are hugely beneficial approaches that rely on CBT,

CBT is much more expensive, time-intensive, and less effective for weight loss than GLP-1 drugs. It also scales incredibly poorly, as you need a huge number of therapists. There are roughly a hundred million obese Americans. We can make enough drugs to treat all them, but can we make and pay for several million therapists to perform CBT on all of them, all for less efficacy than the GLP-1 agonists? Fat chance.

Moreover… who cares? Viagra was a failed angina treatment. Valium was originally a dye

So?

Quite frankly this is an incredibly absurd statement. Do you realize that our brains entirely control our behavior? An issue with self control is a brain issue, and very well may be an endocrine issue. Are you an endocrinologist?

It doesn't work for nearly as many people as GLP-1 agonists do. There are many different treatment methods that have been tested and evaluated, and being told to diet and exercise through therapy barely works at all. GLP-1 by contrast works very well.

> At some point, we may find that these drugs cause long-term health problems of their own, too.

Almost sounds like wishful thinking on your part -- you might want to stop and consider why you're so invested in these drugs having long-term side effects.

https://bpsmedicine.biomedcentral.com/articles/10.1186s13030...

CBT is very good at breaking addictions and other bad thought patterns, and it is the scientific basis on which most hard drug rehabs work. There's no reason to suggest that it works less on food than on heroin.

And nobody said it did. But the thought that obese people haven’t considered therapy is absurd. Most of them do so for depression, not the obesity, but they are usually related.

The people who GLP-1 drugs help have not “never tried anything,” including but not limited to “real therapy.”

If CBT and other modalities help someone, great! But they often don’t, and when they don’t, it’s absurd to want them to continue to suffer instead of get help with medication.

Citation needed. As I understand it, serious therapeutic psychological treatments for obesity are highly stigmatized in the US. You may be projecting your own experience onto a group that does not share it.

By the way, CBT as used for depression and for obesity are totally different types of CBT. CBT methods are highly tailored to the specific thought pattern you want to prevent.

And yes, I’m familiar with the differences. I was simply saying they usually walk in with depression, and move on to obesity.

26% and climbing in the UK. 19% and climbing in Germany. 17% in France. 11% in Switzerland - and another 30% overweight. 20 years ago America was 32% obese. Do you want to bet that this is a uniquely American thing? That these numbers won't continue to climb in Europe? Hell, we're seeing them climb in Asia - South Korea's obesity rate among men went from 3.26% to 7.3% from 2009 to 2019, though women increased at a much slower rate.

> Sure, you can just literally throw money at the problem that is too scary for you to tackle it headfirst, or you can have a wake up call and make your life significantly better from now on and live longer. All is connected - it leads to higher confidence, happier healthier life. The key is to walk the hard path - overcome such a challenge will redefine who you are for the better. Taking pills every day because you can't avoid eating a cookie under stress won't, in contrary.

And plenty of people can keep moralizing about how everyone should do it The Proper Way and refusing to understand that while, yes, it is within the power of humans to overcome things with willpower, that there are situations that cause it to require significantly more willpower for some.

> Kids don't eat garbage because parents don't give them garbage, because parents don't eat and overeat on garbage.

This is a great example. A significant number of people end up obese because they're poor. This seems silly at first, right? Go to the grocery store, buy good whole food, cook, save money! There's problems with this: Many poor people work long hours and have difficulty finding the time or energy to cook. Even when they do, many of the cheapest food items are also the most calorie dense and worst calorie:satiety ratios. So this starts them on a cycle of eating the sort of food that makes you fat. And then the fatter you get, the more feedback cycles you have encouraging you to continue getting fatter - such as the well researched links between obesity and leptin. So they get fat, their kids get fat, and it becomes ever more difficult to stop being fat, all because that's the food they could afford to feed their families with.

Every one of those poor Americans has a vote. One vote per person, same as rich people. Experts have long noted that there are more poor people than rich people. There's nothing stopping them from doing what western Europeans did, vote in leaders who provide better working conditions, better worker protections and better pay, and other policies that reduce poverty.

If only there were a drug that suppressed political defeatism.

On the local level, gerrymandering can quite literally stop them from doing that.

I think folks using drugs (or meditation or habits or diet or any other thing) to intentionally make their life better is amazing and should be celebrated.

If some things are easy for you but not others try to be grateful for yourself without having to be petty or wanting others to be worse off.

Much like if we geoengineered cloud seeding or similar light blocking and fail to reduce CO2, the treatment masks the cause and can lead to worse outcomes globally (even if some folks are better off - and I hope they are!).

However, if they are, then modern life is a sledge hammer that’s constantly breaking your legs.

Our (US, UK, Australia and so on) life styles and food chain have created this obesity problem.

We are now a sedentary population, and low-nutrient high-calorie food is being made readily available to stressed, tired, overworked, and economically challenged people. When you are stressed and tired, you don’t make the best choices!

These drugs are not so much a crutch as they are a rescue helicopter!

We still need education though.

These drugs might reduce hunger, but they won’t stop you from consuming junk-food. People are used to overeating, and a feeling full isn’t always what’s stopping them from eating!

So we do absolutely need to address the root of problem….

Yes, but once you’re rescued you hopefully try to avoid falling in the same situation that lead you to have to be rescued the first time. This should be a double approach solution, a short term (the drug) and a long term ( lifestyle changes) it can be done with the second only but personal commitment is required. Besides that we, as a society, are not accustomed to “subtractive solutions” they’re simply never considered or pushed by anyone because there’s no money on them. Money is in “creating solutions” not in “eliminating problems”

What is more, getting hung up on the wording is missing the larger point.

People with pacemakers can't get off of them either, but it doesn't have the same stigma. Diabetics often need regular insulin injections, but it doesn't have the same stigma. People with high-blood pressure often need regular medication, but it doesn't have the same stigma. It's mostly antidepressants and now Ozempic which have this stigma.

> A set of habits and lifestyle are pretty much the same thing.

I believe the DSM does not consider them "pretty much the same thing".

'Learn from a new' is missing an object.

It can be very hard to avoid booze or cigarettes. They are everywhere. Potentially throughout all of a person's social group. Maybe at home if spouse or parents smoke.

As a former smoker, changing diet was easier for me than to change a smoking habit

If the same logic applies to a "food addiction", then discontinuing the drug that helped you go over the initial addiction is going to be almost impossible, since you can't abstain from food.

We are mostly on the same page I think. To the point though, re: food - it is not all equal. Fast food, ice cream, fried food, candy, chips- it is quite different from cooking your own meals and snacking on things like fruit, veggies and hummus (etc..)

Similar to your first point, I can't buy ice cream because I have no self control over it. (I would not say I have a food problem, it would therefore be a lot harder for others I believe)

While I agree "you can't abstain from food", it might be a bit overly reductive. Not all food is responsible for 'problem' eating. Similar to near absolutely (or absolutely) avoiding booze/nicotine, there might be similar foods that must be avoided. Which comes back to habits, changes to how a person snacks, when they eat, how long is spent in food prep,more grocery store trips, how they shop in the grocery store (etc)

So, it's easy to only think about how good it makes you feel at the moment.

But alcohol will show nasty side effects rather sooner than later, it will show on your face, you will feel liver problems very fast and since you are in a secondary state when inebriated you will seem out of place when not in that state.

Both of those substances have the particular effect that if you use them repeatedly over a short (1-2 week) period of time in moderate but sustained quantities, you will get chemically addicted. This is nasty and the reason why every parent tries to make this fact known to their children (more or less successfully depending on method).

Food addiction in my opinion is very different, it comes purely from psychological factors and should be very easy to correct on time. It's not something that comes around in 1 week or 2. Even if you overeat 1000 kcal (1/3 more than the average of 2000) over the course of 2 weeks, you would only gain 2kg of body fat at worse. It's really a very long sustained process to really become obese, it's not like chemicals that can get you in 2 weeks max.

While it's hard to lose what you gained (you basically need to starve a little bit) it's not that hard to make adjustment to life choice to avoid making the situation much worse.

Despite not being overweight and taking regular exercise, I have recently been diagnosed as diabetic and now see the world in a different light. It really is quite shocking how many aisles in. a typical supermarket are stocked with complete junk food.

Is it impossible to buy healthy food in your region? The average American spends six hours a day watching TV, do they really not have enough time to cook a meal? Just how many people do not have a cooker in their home? Is it cheaper to buy preprocessed food rather than the raw ingredients in that meal?

It seems to me the real problem is the supply of food is abundant and corporations have gone to extraordinary lengths to make it very palatable. Add in peoples tendency to chose the easy option (ready meals, eating out) and you get an obesity epidemic.

Empathy can go a long way and the more we can have for each other the better we will collectively be.

If you want to solve the problem you have to understand it. I see lots of dubious suggestions like lack of time when working hours have reduced massively in recent history[1].

>Empathy can go a long way and the more we can have for each other the better we will collectively be.

If our read my second paragraph then you will see I'm not laying the blame at individuals.

[1] https://ourworldindata.org/working-hours

You can easily tell this is the case by seeing where the obesity is less prevalent

Your entire body and brain is a complex and messy chemical reaction.

The opening sentence of the wikipedia article on addiction currently reads: "Addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behavior that produces natural reward, despite substantial harm and other negative consequences."

The page then lists "eating or food addiction" as examples, with food addiction being its own entire page.

More likely it's listed as one so insurance company pay for the drugs.

Addiction treatment gets payed, low self control not.

Half Bake- Thur good goes to rehab NSFW

https://youtu.be/uUPHlAbAf2I?si=TVVxffFprAtdJyAk

Brains are fascinating. There is a choice being made every time someone with gambling addiction goes to gamble or someone with a smoking addiction goes to smoke, but that doesn't mean they're not experiencing addiction/withdrawal distorting the ability to make that choice in a healthy fashion. Some people do manage to quit smoking by just making a decision one day to stop and sticking with it, with no assistance whatsoever; that doesn't mean they weren't experiencing addiction/withdrawal. There are, in fact, mechanisms that encourage addictive behavior, ranging from social media use to alcohol to food to MMORPGs. Not everyone who uses those things, even to excess, has an addiction. But some do. And breaking that addiction is laudable, whether with or without assistance.

Rather, you sound like you would be saying that "quitting alcohol is merely a question of personal choice" if you had struggled with alcohol rather than weight.

> I realize people are trying to make over opiod abuse into some sort of addiction. It makes it easier to not blame the person and absolves them of all personal responsibility for their condition - they just can't help themselves, don't ya know!

I change one addiction to another addiction. If people find the above distasteful, I agree, but my question is why do you believe one thing for food addiction and another thing for other addictions?

So their addiction was a choice - and now they have developed a chemical dependency which is no longer a choice.

There is no such chemical dependency from eating two cheeseburgers for dinner instead of one.

That doesn't mean that it's not within the means of human willpower to overcome it - everyone has the power to not be obese. But that doesn't mean that it isn't significantly harder for some people based on their genetics, biochemistry, the feedback loop of being obese, etc.

Wouldn't the initial dependency be almost purely psychological for opioids as well? Most people certainly wouldn't develop a chemical dependency after just two doses as well.

> developed a chemical dependency which is no longer a choice.

Why? They still have a choice. Of course it might be much harder for them to stick with that choice than for someone suffering from a mainly psychological addiction.

And even then, you do have a chemical dependancy on enough calories, that dependency led to an evolved response mechanism, that mechanism is exploited by junk food manufacturers. That the substances your body and brain produce in response to food stimuli are endogenous (made in your own body) rather than exogenous (made outside) doesn't make them magically less potent — some of us can get past this with our willpower*, but observationally it's obvious that most of us can't.

* I seem to have a lot of willpower, but I suspect that's mainly that my conscious self is fairly oblivious to my body's needs, as my willpower also leads to me pushing myself too hard in various different ways.

Apparently not in your body, no. Or maybe you just failed to recognize what addiction is, and managed to overcome it. Good job!

Now stop trying to pretend that your lived experience equals everyone else's because it clearly doesn't.

Since we know this phenomenon is real, this means that, even with a chemical dependency, people choose whether to take the drug or not. So, by your logic, they are not really addicted, they can just choose to stop at any time, they're just silly and weak people, right?

Of course this is reductive and simplistic. Ultimately your choices are a computation that your entire nervous system makes, and urges and cravings are a component of that, just like rational processes are. Different people's nervous systems weigh these factors differently, and have more or less powerful cravings and urges to begin with. It's absurd to think that your rational thinking can overwrite anything in any condition, and it's absurd to think that all people experience these thinks to the same extent.

Or if burgers were a thing you had to go to an illegal dealer for.

These are all choices.

Just because you can do something, doesn't make it a "just" for everyone:

• Without any training, one day I decided to put one foot in front of the other and keep going, and managed 42 km, a literal marathon in distance — but it's obvious that, even though I was walking, most people can't do that.

• When I was at university, I gamified my diet to be the lowest cost without feeling hungry, and in retrospect that was probably 1100 kcal/day and only even safe because it was limited to term time, and it's really obvious that most people can't do that.

• Concersely, when I was on antidepressants and did graze myself into obesity, there simply wasn't a part of my mind aware of what I was doing to myself. I've lost that weight, but the strech marks are still there a decade later.

These are all things that we acknowledge are possible to be addicted to to that are not substances. Not to mention that coke has caffeine which is a chemical substance just as much as anything.

You can pin addiction to anything as a personal weakness, including drugs. Why are some people able to smoke a few cigarettes or do a little bit of cocaine without ever getting addicted, when others are hooked on day one?

If there's one thing that's been fun to see as the outcome of GLP-1 drugs, it's that a lot of people seem to have a real problem seeing people better themselves the "easy way".

Sure, you don't take the substance directly. But the things you do have your body produce/release the substance.

A dopamine high is a dopamine high. Even though you didn't buy a dopamine pill from a shady dude in the parking lot.

Addiction is basically highjacking our brain wiring that’s meant to help us expend energy chasing things that we need for survival (food, reproduction), and using it to chase other things

(When I feel charitable, I can instead wring my hands and hemm and haww about the unknown consequences of people using medication to solve their health problems. I can't outline what exactly those consequences are, but I can certainly hemm and haww.)

Compulsive overeating relies on the same behavioral/reward mechanisms, with the added bonus of food being something you do physically ingest in the process.

When I was a poor teenager I was gambling online and it is an incredible way to lose money unlike anything. With the click of a button you can throw $100 or $1000 into the void- and you often follow it up until your account is empty. Hard to do with many other substances.

I think avoiding bad foods is a better solution than reaching for drugs, but if the drugs help break the cycle, it could be beneficial.

If you listen to nutrition gurus, you'll hear claims like "food X contains chemical Y and chemical Y is either itself toxic or metabolizes to something toxic, therefore you shouldn't eat X". I promise you I can find videos where somebody has found something bad about spinach and will try to convince you not to eat it. It's a bad way to reason.

Identifying individual biological pathways isn't enough to make (dietary) prescriptions. Often, the metabolites of the food aren't produced in high enough quantities to make a measurable effect (on health, or this case behavior). This kind of thing has to be studied at the level of behavior.

Addiction hits the same part of the brain, no matter if it's chemical, physical, or digital. Just because our culture sees them differently doesn't make it the same underlying problem.